Table of Contents
Praise
ALSO BY ELAINE TYLER MAY
Title Page
Dedication
Introduction
Chapter 1 - Mothers of Invention
Chapter 2 - The Population Bomb
Chapter 3 - Bedfellows
Chapter 4 - The Sexual Revolution
Chapter 5 - A Pill for Men?
Chapter 6 - Questioning Authority
Chapter 7 - The Pill Today
Conclusion
Acknowledgements
NOTES
INDEX
Copyright Page
PRAISE FOR ELAINE TYLER MAY’S
America and the Pill
“Elaine Tyler May is one of those rare historians who can take a set of complicated issues and make them both fascinating and
comprehensible. This book belongs on the bookshelf of anyone who wants to understand how the Pill changed the lives of
women—and men.”
—Margaret Marsh,
Professor of History at Rutgers University
and coauthor of The Fertility Doctor:
John Rock and the Reproductive Revolution
“With characteristic clarity and wit, May has produced a compelling history of oral contraception that incorporates medicine,
morals, and popular media. In concise and carefully crafted chapters, she honors the feminists who enabled the initial research,
explores the utopian hopes that the pill would solve world problems, and exposes the myths about its revolutionary impact.
This balanced assessment of the pill takes into account not only science, religion, and the law, but especially brings to light the
complex voices of the women who have both embraced and rejected oral contraception. A wonderful read for students and a
timely source for professionals and the public concerned about sexuality, reproduction, and social policy.”
—Estelle B. Freedman,
Edgar E. Robinson Professor in U.S. History at
Stanford University and author of No Turning Back:
The History of Feminism and the Future of Women
“It takes a top-notch historian to separate myth from fact. On the historic 50 th anniversary of the birth control pill, Elaine Tyler
May reminds us that modern contraception has not been a destabilizing force, as so many fear-mongers would have us believe.
To the contrary, it has served as a powerful agent of change in the lives of married women liberated to balance work and family
and to realize their full potential as human beings. By helping to elevate the status of women, birth control has promoted
prosperity and well-being in America and around the world.”
—Ellen Chesler,
author of Woman of Valor: Margaret Sanger
and the Birth Control Movement in America
“Before the iPod, before email, before personal computers even, the technology that truly changed the country was one little
pill. Elaine Tyler May explores everything from population control to Playboy, libido to liberation, in this fascinating look at
how the birth control pill has affected Americans at work and play since its inception in 1960. May’s eye for colorful anecdotes
and cultural iconography makes this a delightful journey. Women who remember when the pill was approved by the FDA will
rejoice in this hindsight view of how it influenced the personal and the political, while a new generation will feel deeply
grateful for the rights and liberties that they’ve taken for granted. This is history for people who are serious about sex.”
—Courtney E. Martin,
author of Perfect Girls, Starving Daughters:
The Frightening New Normalcy of Hating Your Body
and Editor at Feministing.com
ALSO BY ELAINE TYLER MAY
Homeward Bound: American Families in the Cold War Era
Barren in the Promised Land: Childless Americans and the Pursuit of Happiness
Pushing the Limits: American Women, 1940-1961
Great Expectations: Marriage and Divorce in Post-Victorian America
Created Equal: A History of the United States (with Jacqueline Jones, Peter Wood, Thomas
Borstelmann, and Vicki Ruiz)
Tell Me True: Memoir, History, and Writing a Life (co-edited with Patricia Hampl)
Here, There, and Everywhere: The Foreign Politics of American Popular Culture (co-edited with
Reinhold Wagnleitner)
In memory of my parents,
Edward T. Tyler and Lillian B. Tyler,
Birth Control Pioneers
Introduction
If [an oral contraceptive] could be discovered soon, the H-bomb need never fall. . . . [It would be] the greatest aid ever
discovered to the happiness and security of individual families—indeed to mankind. . . The greatest menace to world peace and
decent standards of life today is not atomic energy but sexual energy.
John Rock,
clinical researcher of the
oral contraceptive, 1954 1
It was the spring of 1960. The U.S. Food and Drug Administration had just approved the oral
contraceptive for marketing. The pill’s arrival marked the culmination of years of development and
testing and heralded a new era in the long history of birth control. For the first time, a method of
contraception separated birth control technology from the act of sexual intercourse and was nearly 100
percent effective. Women wasted no time demanding prescriptions—a surprise to doctors, who
normally told their patients what to take, rather than the other way around.2 Within two years of its
approval, 1.2 million American women were taking the pill every day. By 1964 the pill was the most
popular contraceptive in the country, used by more than 6.5 million married women and untold
numbers of unmarried women.3 But “the pill,” as it quickly came to be known, was more than simply
a convenient and reliable method of preventing pregnancy. For its advocates, developers,
manufacturers, and users, the pill promised to solve the problems of the world.
In 1960, those problems seemed daunting. The nation was in the midst of cold war with the Soviet
Union, locked in a battle for the hearts and minds—and markets and political alliances—of peoples
around the world. Former colonies were gaining their independence, and the two superpowers vied for
their allegiance. American officials feared that communism might take hold in the developing world
as a result of widespread poverty, due in part to the rapidly rising global population. They also
foresaw that overpopulation could lead to human misery, unrest, violence, and war.
At home, the nation was in the midst of the baby boom. Couples married young and had children
quickly. Yet American women were growing restless. They were eager for a reliable contraceptive that
would free them from constant childbearing so they could take advantage of new opportunities
opening up for women outside the home. At the same time, the sexual revolution was churning just
below the surface of domestic tranquillity. Despite the taboo against premarital intercourse and the
widespread celebration of marriage and family, the trend toward sexual activity without wedlock had
already begun. A youth culture was emerging that would challenge many of the social, political, and
sexual norms of the past, and the feminist movement was on the horizon. In 1960, when the Food and
Drug Administration (FDA) approved the pill, the forces swirling around its arrival clashed in
thunderous clamor.
While some observers and commentators feared that the pill would wreak havoc on morals and
sexual behavior, others claimed that it would cure the social, sexual, and political ills of the day. In
keeping with the military metaphors that permeated life in the early cold war era, many saw the pill as
a “magic bullet” that would avert the explosion of the “population bomb.” By reducing the population,
it would alleviate the conditions of poverty and unrest that might lead developing nations to embrace
communism, and instead promote the growth of markets for consumer goods and the embrace of
capitalism. The pill would also bolster the “nuclear” family in the nuclear age with its promise of
marital bliss. By freeing married couples from fears of unwanted pregnancy, it would foster planned
and happy families—the key to social order. Medical and pharmaceutical promoters of the oral
contraceptive often cast it as the means to this end, with success marked by the achievement of
national and global transformation.
Curiously, the pill’s most vocal advocates were relatively quiet regarding the impact of oral
contraceptives on those who would take them every day: women themselves. With the exception of
Margaret Sanger and Katharine McCormick, two elderly activists in the women’s rights movement
who were responsible for the development of the pill in the 1950s, few of the pill’s earliest advocates
saw its potential to liberate women. Women, however, saw it as precisely that. When the birth control
pill arrived on the market, it unleashed a contraceptive revolution. For the first time, women had
access to an effective form of birth control that did not require men’s cooperation or even their
knowledge.
The pill was indeed revolutionary, but it was not the first reliable birth control method. For
centuries, women as well as men had found ways to suppress fertility and avoid pregnancy. Prior to
the arrival of the pill, men controlled two of the most widely used methods: condoms and withdrawal.
Women employed a variety of barrier methods, such as sponges, pessaries, and the diaphragm.
Abortion was widely used as a method of birth control, and surgical sterilization was also available.
Potions and remedies of various sorts appeared on the market in the nineteenth and early twentieth
centuries. Sold as a means to “regulate” the menstrual cycle, they often came with bold warnings that
their use might prevent pregnancy or cause miscarriage. Women rushed to buy these products to
achieve the dire consequences advertised on the product’s packaging.
In the 1950s, pharmaceutical companies gained FDA approval for a hormonal compound that would
cure menstrual irregularities by temporarily suppressing ovulation. Realizing its contraceptive
potential, half a million American women suddenly sought medication for “menstrual irregularity,” a
condition rarely treated prior to the availability of the ovulation-suppressing remedy. In 1960, the
FDA approved this compound as the first oral contraceptive, Enovid, manufactured by the G. D. Searle
pharmaceutical company.
Having full control over contraception was a mixed blessing for women, because it relieved men of
any responsibility for preventing pregnancy, leaving the burden entirely on the female partner. At the
same time, the pill brought a third party into the equation: the doctor. Although the diaphragm, too,
involved medical intervention for the initial fitting, there was no need to see a doctor thereafter. The
pill, however, required regular checkups and monitoring. A doctor had to authorize every prescription
and every refill. At first, few women complained about this intervention. As medical experts, doctors
carried tremendous prestige and respect in the decades following World War II, when science and
medicine gained unprecedented stature. This was the era of the expert, and experts seemed to be
solving problems right and left. Americans were well primed to place their faith in scientists, doctors,
and the pill to solve global, social, and personal problems. Advances in medicine yielded penicillin
and the polio vaccine, tranquilizers to calm Americans’ nerves in an era of anxiety, and now the pill,
which promised to make unwanted pregnancy a thing of the past.
But the pill also empowered women to make demands on their physicians—initially by asking for
prescriptions and later by insisting on more information and safer oral contraceptives. Within a few
years of its FDA approval, as side effects and dangers became apparent, women came to realize that
although the pill might solve some of their problems, it could also create many more. As the feminist
movement gained momentum, women’s health advocates protested pharmaceutical companies’
indifference to their well-being and demanded government action.
Women were not the only ones affected by the pill. For every woman taking or contemplating the
pill, there was at least one man involved. Men responded to the pill primarily through media
spokesmen, who took up the social, sexual, and moral implications of oral contraceptives. Although
some men found it liberating to be free of the possibility of impregnating their partners, others found
the power and autonomy it gave to women threatening to their masculine egos. Meanwhile,
researchers tried to develop a pill for men—an effort that continues to this day.
As it turned out, the pill did not solve all the problems of the world. It did not eradicate poverty, nor
did it eliminate unwanted pregnancies or guarantee happy marriages. But it became a major player in
many of the most dramatic and contentious issues of the last half of the twentieth century: the quest
for reproductive rights; challenges to the authority of medical, pharmaceutical, religious, and political
institutions; changing sexual mores and behaviors; reevaluation of foreign policy and foreign aid; and
women’s emancipation. The pill did not cause any of these developments or determine their outcome,
but it was a hot-button issue for debate amid the social and cultural upheaval of the time. Eventually,
the pill took its place not as the miracle drug that would save the world, but as an important tool in
women’s efforts to achieve control over their lives.
Although the developers of the pill came from many different countries and its impact was felt
globally, in many ways the story of the pill is an American story. Two American women, Margaret
Sanger and Katharine McCormick, succeeded in getting the pill developed; it was mostly American
researchers and physicians who created and tested it, primarily American pharmaceutical companies
that initially marketed it, and American women, overwhelmingly, who consumed it.
Millions of women have their own personal stories about the pill, and some of them are contained
in the pages that follow. Through an Internet survey, I received e-mails from hundreds of women and
a few men. Respondents of all ages, backgrounds, religions, and sexual orientations told me their
stories. They wrote of the impact of the pill not only on their bodies and their fertility, but also on
their lives. They help provide the personal dimension to the history of the pill during its first half
century.4
I TOO HAVE A STORY. THE PILL HAS SPECIAL RESONANCE for me because my parents were
involved in its early development and distribution. I was twelve years old in 1960, when the pill came
on the market. I probably knew more about oral contraceptives than most girls my age. Dinner-table
conversation often revolved around my father’s work as a clinical researcher testing the pill in his
private practice, or my mother’s efforts to establish birth control clinics in Los Angeles where the pill
was offered free of charge and my father served as medical director. I remember the press swarming
around my father’s office, and I watched when he was interviewed. Would the pill make women
promiscuous? No, he insisted. Like most of the pill’s advocates, he disapproved of premarital sex and
believed that single women who engaged in sex would do so with or without the pill. But he hoped the
pill would prevent unwanted pregnancy.
I tagged along to medical meetings where the pill was a hot topic. I remember debates and
controversies about side effects and risks, and my father’s frustration at the lack of a perfect control
group to compare the health of pill-taking and non-pill-taking women over a long period of time.
People I knew as my father’s friends and colleagues I would later read about as birth control pill
pioneers.
I was also a “human guinea pig” for the pill. In the early 1970s, after I was married, I asked my
father what pill I should take. He suggested that I join the clinical trial of a low-dose pill being tested
at the time. I dutifully showed up for the frequent medical checkups and lab tests required of study
participants. My medical records are among the thousands used to document the safety and
effectiveness of the low-dose pill.
Although I knew my father was involved in research on the pill, until I began working on this book I
had no idea that he played a key role in the FDA approval process. As I read recent work by scholars
in the field of medical history, I discovered that my father’s caution and uncertainty about the safety
of the pill delayed its approval, to the annoyance and consternation of the oral contraceptive pioneers
John Rock and Gregory Pincus. The FDA refused to approve the pill for market until my father gave
the green light. Prompted to write this book because the fiftieth anniversary of the pill’s approval was
approaching, I was astonished to find my father at the center of that momentous event.5
So while my interest in the pill predates my life as a historian, I now understand the events that
swirled around me in a new way. This study of the pill also dovetails with my long interest in
women’s history, particularly the relationship between private life and public policies. Questions of
politics, gender, sexuality, fertility, and reproduction have all been central to my work—and are all
central to the history of the pill. As the fiftieth anniversary of the pill’s FDA approval approached, I
decided to investigate its impact on our lives and our world.
I wish I had been able to interview my parents for this project, to gain their wisdom and insights,
hear their stories, and have them read and comment on my drafts. But they are no longer with us, so
the best I can do is to dedicate this book to their memory, with gratitude for the work they did on
behalf of women’s reproductive freedom.
1
Mothers of Invention
You wined me and dined me
When I was your girl
Promised if I’d be your wife
You’d show me the world
But all I’ve seen of this old world
Is a bed and a doctor bill
I’m tearin’ down your brooder house
’Cause now I’ve got the pill
All these years I’ve stayed at home
While you had all your fun
And every year that’s gone by
Another baby’s come
There’s a-gonna be some changes made
Right here on nursery hill
You’ve set this chicken your last time
’Cause now I’ve got the pill
This old maternity dress I’ve got
Is goin’ in the garbage
The clothes I’m wearin’ from now on
Won’t take up so much yardage
Miniskirts, hot pants, and a few little fancy frills
Yeah I’m makin’ up for all those years
Since I’ve got the pill
I’m tired of all your crowin’
How you and your hens play
While holdin’ a couple in my arms
Another’s on the way
This chicken’s done tore up her nest
And I’m ready to make a deal
And ya can’t afford to turn it down
’Cause you know I’ve got the pill
This incubator is overused
Because you’ve kept it filled
The feelin’ good comes easy now
Since I’ve got the pill
It’s gettin’ dark it’s roostin’ time
Tonight’s too good to be real
Oh but daddy don’t you worry none
’Cause mama’s got the pill
Oh daddy don’t you worry none
’Cause mama’s got the pill
Loretta Lynn
The Pill, 1975 1
Country singer Loretta Lynn’s rebellious anthem, the first popular tribute to the pill in music, tells the
story of a woman whose dreams of marital bliss and adventure have been thwarted by constant
childbearing. Resentful of her husband whose prenuptial promises went unfulfilled as she stayed home
to tend to their brood, she declares her independence with sexy clothes and good times, thanks to the
pill. But she does not abandon her mate. The last verse of the song hints at one of the pill’s initial
promises: satisfying marital sex. She tells her man that without worries about pregnancy “the feelin’
good comes easy now” and invites him to a night of pleasure. She lets him know that the pill has
positive benefits for him as well as for her: “Oh daddy don’t you worry none / ’Cause mama’s got the
pill.”
Loretta Lynn’s song articulates the hopes for liberation the pill promised to women. She sang to and
for women who saw the pill as providing freedom from the fear of pregnancy and offering the
opportunity to enjoy their sexuality with their chosen mates. Like the vast majority of women who
took the pill, the song’s protagonist was married, and her dreams had been displaced by the birth of
one baby after another. The pill offered her a chance once again to reach for her dreams.
By the time Loretta Lynn belted out her hit song in 1975, the pill had been on the market for fifteen
years and millions of women were taking oral contraceptives every day. As Lynn’s lyrics suggest, the
story of the pill is a story about women. That fact may seem obvious to twenty-first-century readers.
But when the pill first came on the market in 1960, few people imagined how powerful a force for
women’s emancipation it would become. The scientists and medical researchers involved in the pill’s
development hailed it as a miracle drug that would solve the global problem of overpopulation,
thereby reducing poverty and human misery, especially in the developing world. They also saw the
pill as the key to family planning, allowing couples to space their children, enjoy marital sex, and
achieve domestic harmony. But women had other hopes for the pill, and it was their dreams that
brought the pill to fruition and made it a powerful tool for change.
The story of the pill is shrouded in myths and misconceptions, particularly as regards the central
role women played in its development. The names most closely associated with the pill’s arrival are
Carl Djerassi, who first discovered how to synthesize the hormone progesterone from Mexican yams;
Gregory Pincus, the scientist who discovered how to use this synthetic progesterone, known as
progestin, to inhibit ovulation; and John Rock, the physician who first tested the pill on human
subjects and became its most visible champion. But these men did not initially set out to develop an
oral contraceptive. Many of the developers of the pill were trying to find a cure for infertility, an
effort that led them to contraceptive research.
In spite of competing claims of paternity, there was no “Father of the Pill.” In fact, the pill had two
mothers: birth control pioneer Margaret Sanger and the wealthy women’s rights activist Katharine
McCormick. Both were in their seventies at the time they began their collaboration. As lifelong
feminists, they had participated in decades of activism on behalf of women’s rights. They knew that
women could not achieve full equality unless they had control over their reproductive lives. Although
the two would never benefit from the pill themselves, it was Sanger and McCormick’s tireless efforts
that made the pill possible.
THE WORK OF SANGER AND MCCORMICK BUILT UPON centuries of women’s efforts to control
their fertility. In the United States, by the nineteenth century contraceptive practices were widespread
and reasonably effective, resulting in a dramatic decline in the birthrate. In 1800, American women
had an average of eight children. By 1900 that number had declined by half. Nineteenth-century
women controlled their fertility through several different means: late marriage or no marriage, sexual
restraint, coitus interruptus, barrier methods such as the condom, pessaries (suppositories inserted in
the vagina to kill sperm or block its entry into the uterus), and abortion. Abortion was common and
generally accepted until “quickening,” the point at which a woman can start to feel the movement of
the fetus, which usually occurs about four months into a pregnancy.2
Among the experiments in fertility control were those adopted by utopian and religious
communities that sought to alter sex, gender, and family arrangements as well as reproductive
practices. The Shakers did away with sex altogether; Mormons established polygyny; and the Oneida
Perfectionists turned to “group marriage” in which the community’s leader gave certain couples,
selected according to eugenic principles, permission to procreate, and everyone else was allowed to
have sex with whomever they wished as long as they practiced “male continence”—intercourse
without ejaculation. Women’s rights leaders also called for new approaches to sex, marriage, and
reproduction. They promoted “voluntary motherhood,” which would give women the right to decide if
and when to have children. Some radical activists went further. “Free love” advocates like Victoria
Woodhull and anarchists like Emma Goldman sought to liberate women from the shackles of marriage
altogether.3
It was not until the late nineteenth century that policies limiting access to birth control and abortion
began to develop, promoted largely by the emerging medical profession, whose mostly male
practitioners sought to take control over the process of pregnancy and birth from midwives and lay
healers. At that time, zealous campaigners against all forms of behavior they considered to be
immoral took aim at contraception, calling it a “vice.” The most aggressive was Anthony Comstock, a
United States Postal Inspector and longtime vice crusader who began a campaign against all forms of
birth control. In 1873 a federal law named for Comstock equated birth control with pornography and
prohibited all contraceptive information and devices from being sent via the U.S. mail. The Comstock
Law restricted access, but it did not prevent women from obtaining birth control. Women shared
information with each other by word of mouth and found ways to transport devices without using the
mail system. They also mounted challenges to the law that eroded its prohibitions. Advertisements for
contraceptives used euphemisms such as “effective for female disorders,” or contained warnings that
“special care should be taken not to use the remedy after certain exposure has taken place, as its use
would almost certainly prevent conception.” In spite of such efforts to get around the Comstock Law,
it remained in effect for more than half a century.4
As the women’s rights movement gained momentum in the early twentieth century, activists
demanded not only the vote but also equality in marriage, access to divorce, and the right to engage in
or refuse sex and reproduction. The birth control movement emerged as part of this wide-ranging
feminist agenda. Both Sanger and McCormick began their careers as women’s rights activists during
this time. At that point, birth control advocates promoted contraception as a radical idea linked to
political change as well as personal emancipation.5 Margaret Sanger and Katharine McCormick were
part of this movement for radical change. Their dream for a contraceptive that would be entirely
controlled by women emerged at this time. Sanger, a feisty socialist and militant feminist, came from
a working-class background. Her radicalism drew on her roots. Writing in The Woman Rebel , a
periodical she began publishing in 1914, she declared, “The working class can use direct action by
refusing to supply the market with children to be exploited, by refusing to populate the earth with
slaves.”6 Sanger coined the term “birth control” in 1915, and within a few years she asserted her
leadership of the movement that would be her driving passion for the rest of her life.7
Sanger’s woman-centered approach to contraception emerged directly from her personal
experience. The sixth of eleven children born to Irish Catholic immigrant parents, she watched her
mother weaken and die at the age of fifty. She blamed her mother’s premature death on constant
childbearing and lack of access to contraceptives. Working as a nurse, Sanger also encountered many
women who became sick and died from illegal abortions or, like her mother, simply having too many
children. She also considered contraception necessary to ease fears of pregnancy so that women could
enjoy sex. Margaret Sanger expressed her hopes for a “magic pill” to prevent pregnancy as early as
1912 when she was thirty-three years old.8
But Sanger’s advocacy of birth control was thwarted by legal restrictions, especially the Comstock
Law. Along with many other birth controllers, Sanger challenged the law in several acts of civil
disobedience. During these years, at least twenty birth control activists went to prison on federal
charges.9 Sanger was first arrested in 1914 for promoting contraceptives in The Woman Rebel . Rather
than face incarceration, she fled the country and spent the next two years in Europe. While she was
away, her husband, William Sanger, was arrested for distributing “Family Limitation,” a birth control
pamphlet written by his wife. In a raucous courtroom scene, William Sanger confronted Anthony
Comstock as the assembled crowd of Sanger’s supporters—including a number of well-known
socialists and anarchists—hooted, jeered, and shouted at Comstock and the judge until the rowdy
spectators were removed from the courtroom. The judge convicted Sanger, declaring the pamphlet
“immoral and indecent,” and scolded, “Such persons as you who circulate such pamphlets are a
menace to society. There are too many now who believe it is a crime to have children. If some of the
women who are going around and advocating equal suffrage would go around and advocate women
having children they would do a greater service.”10
In 1916, Margaret Sanger returned to face her own trial, and went to prison for opening the first
birth control clinic in the United States. Although her clinic was in violation of the law, her strategy
was to work with doctors to lend her movement legitimacy. That strategy served her well in the long
run. After her release, she challenged the law that prohibited the distribution of birth control
information. Although her conviction was upheld on appeal in 1918, Judge Frederick E. Crane
provided for a medical exception to the law that allowed physicians to offer contraceptive advice to
married women for the “cure and prevention of disease.” With this new loophole in the system, Sanger
promoted the establishment of birth control clinics across the country to be staffed by physicians who
could legally provide contraceptive information and devices. She challenged the law again in 1936 in
the U.S. Circuit Court of Appeals. The case, United States v. One Package, allowed physicians to send
contraceptives through the mail, effectively removing birth control from Comstock Law prohibitions.
To promote her crusade for birth control, Sanger compromised her initial radical socialist
principles. In the 1920s, she forged ties with medical professionals, including promoters of eugenics,
whose conservative politics embraced immigration restriction and advocacy of laws for the
sterilization of the “unfit.” She continued to work closely with these physicians as a way to gain
legitimacy for the birth control movement. By 1935, when most birth control advocates were strong
New Deal liberals, Sanger attacked Franklin Roosevelt for his ambivalence about birth control using
eugenic arguments: “As long as the procreative instinct is allowed to run reckless riot through our
social structure . . . as long as the New Deal and our paternalistic Administration refuse to recognize
[the danger this poses], grandiose schemes for security may eventually turn into subsidies for the
perpetuation of the irresponsible classes of society.”11
By this time, the birth control movement had already gained considerable mainstream acceptance
and had lost its radical edge. With the lifting of Comstock Law restrictions and the need to limit
family size during the Great Depression, the number of birth control clinics in the nation grew from
fifty-five in 1930 to more than eight hundred in 1942. In that year, the Birth Control Federation of
America changed its name to the Planned Parenthood Federation of America (PPFA), signaling a
major shift in the movement’s direction. New goals included strengthening the family by making it
possible to plan the timing and spacing of children and by liberating female sexuality in marriage,
leading to happier couples and greater domestic contentment. Improvements in barrier methods,
including the condom and the diaphragm, increased the effectiveness of these contraceptives. 12
By the 1950s, the promise of women’s emancipation faded as the goal of family harmony came to
the fore. Contraception was no longer part of a wide-ranging feminist agenda. In fact, Sanger had
become an outspoken advocate of population control and family planning. As she wrote to Katharine
McCormick, “I consider that the world and almost our civilization for the next twenty-five years, is
going to depend upon a simple, cheap, safe, contraceptive to be used in poverty stricken slums,
jungles, and among the most ignorant people. I believe that now, immediately there should be national
sterilization for certain dysgenic types of our population who are being encouraged to breed and would
die out were the government not feeding them.”13 She still promoted the idea of a simple
contraceptive that would be entirely controlled by women, but held to the belief that the medical
profession should regulate and dispense contraceptives. A birth control pill, which she first imagined
in 1912, remained her ultimate goal.
That dream became a reality as a result of Sanger’s partnership with Katharine Dexter McCormick.
Brilliant, dedicated, and passionate, McCormick was a courageous lifelong activist on behalf of
women’s rights. The two ardent feminists first met in Boston in 1917 at one of Sanger’s lectures, and
they quickly became friends. In contrast to Sanger’s modest economic circumstances, Katharine
Dexter was born into wealth. The child of a successful Chicago lawyer, Katharine had advantages few
young women of her generation enjoyed. She was the second woman to graduate from the
Massachusetts Institute of Technology (MIT). Later she became an active alumna who pushed the
school to admit more women. When it became clear that female students at MIT needed an
appropriate living space, she funded the construction of a women’s dorm. Challenging the status quo
at every turn, she hosted dinners for MIT’s female students and lectured them on the importance of
birth control—a particularly bold move at a time when contraception was not only socially taboo but
also illegal in Massachusetts.14
In 1904, the year she graduated from college, Katharine Dexter married Stanley McCormick, son of
Cyrus McCormick, inventor of the reaper and founder of International Harvester Company. Soon after
their marriage Stanley was diagnosed with schizophrenia. As the disease progressed, Katharine gained
control of their vast estate and devoted her energies and resources to finding a cure for the illness. At
the same time, she remained active in the movement for women’s rights, a cause that attracted many
educated young women of her generation. She became vice president and treasurer of the National
American Women’s Suffrage Association and worked toward gaining women the right to vote. She
also became involved in the birth control movement. In the 1920s, she smuggled diaphragms into the
United States from Europe to supply Sanger’s clinics. Mc-Cormick’s willingness to defy both custom
and law served her well when she teamed up with Sanger to promote the development of the oral
contraceptive pill.
In 1950, three years after her husband’s death, McCormick contacted Sanger to ask how she could
provide financial support for research on contraception. At the time, contraceptive research was
considered a disreputable business. Pharmaceutical companies as well as the federal government
refused to invest in it. In fact, throughout the 1950s, neither the National Science Foundation nor the
National Institutes of Health provided any funds for contraceptive research.15 In 1959, President
Dwight D. Eisenhower proclaimed, “I cannot imagine anything more emphatically a subject that is not
a proper political or government activity or function or responsibility. . . . The government will not, so
long as I am here, have a positive political doctrine in its program that has to do with the problem of
birth control. That’s not our business.” 16 Such resistance did nothing to deter McCormick and Sanger.
Although the Planned Parenthood Federation under Sanger’s leadership contributed small amounts of
funding to early research, it was ultimately Katharine McCormick who bankrolled the development of
the pill.17
Sanger and McCormick teamed up and began looking for someone who would carry their idea into a
laboratory. They continued to insist on the need for a contraceptive that would be entirely managed by
the women who used it. As strong proponents of women’s right to control their own fertility, they
believed it was essential that women have access to contraceptives that did not depend on men’s
cooperation.
THE FIRST TASK FACING THE TWO WOMEN WAS TO find someone to conduct the research.
They set their sights on Gregory Pincus, a scientist with a somewhat tarnished reputation. In the
1930s, while he was an assistant professor at Harvard, Pincus engineered the first rabbit embryo in his
lab. His research provided the foundation for in vitro fertilization, which decades later would become
a standard treatment for infertility. Although his achievement was scientifically important, the media
unleashed a storm of moral condemnation. Pincus was accused of sinister designs. He was even
compared to the villain in Aldous Huxley’s Brave New World who bred babies in test tubes. A 1937
article in Collier’s magazine claimed that Pincus was creating a world of “Amazons” where “woman
would be self-sufficient; man’s value zero.” At Harvard, the bad publicity apparently weighed more
heavily than Pincus’s significant research. In 1936, Harvard cited his work as one of the greatest
scientific achievements in its history—nevertheless, it denied him tenure.18
Relieved to be free from the constraints of academia, Pincus teamed up with Hudson Hoagland, a
Clarkson University biologist, and together they founded the Worcester Foundation for Experimental
Biology. Although he had to scramble for funding, Pincus continued his research. Meanwhile, other
scientists pursued investigations that would contribute to the development of the pill. Chemists Carl
Djerassi and Russell Marker synthesized progesterone from a plant source, the Mexican yam.
Although its contraceptive potential was not immediately evident, Pincus and his colleague MinChueh Chang tested the synthetic hormone, called progestin, for its ability to inhibit ovulation.19
At the Worcester Foundation, Pincus was experimenting with hormonal compounds with the hope
of finding a treatment for infertility. Sanger first met Pincus through Dr. Abraham Stone, the director
of her Research Bureau in New York. In 1951, Sanger granted Pincus $5,100 from PPFA to begin
working on a hormonal contraceptive. Sanger then approached McCormick with a more ambitious
plan to finance Pincus’s research specifically to develop an oral contraceptive. McCormick liked what
she saw at the Worcester facility and pledged to provide Pincus $10,000 per year. She herself had a
scientific background, having studied biology at MIT, and personally oversaw the research as well as
providing financial support. McCormick ended up contributing more than $2 million to the pill project
over the years—the equivalent of about $12 million in year 2000 dollars.20
The collaborators brought to the project a tremendous faith in the possibility of science to solve the
world’s problems and bring about a better future. One of the first women trained as a biologist,
McCormick was both enthusiastic and impatient as she monitored every stage of research. As a nurse,
Sanger had long believed that science held the key to contraception and to women’s emancipation. As
early as the 1920s she had proclaimed, “Science must make woman the owner, the mistress of herself.
Science, the only possible savior of mankind, must put it in the power of woman to decide for herself
whether she will or will not become a mother.” Pincus, brash and confident, was full of optimism
about the possibility of an oral contraceptive. As he set to work on the task, he announced to his wife,
“Everything is possible in science.”21 The flamboyant Djerassi claimed the pill’s invention for
himself, as the title of his book, This Man’s Pill, makes clear.22
The combined efforts of these and other individuals working in various settings and capacities led
to the discovery of the synthetic hormonal compound that suppressed ovulation. Pincus tested the
compound on laboratory animals, but he couldn’t conduct any clinical trials on humans. For this, the
collaborators turned to Harvard-trained obstetrician and gynecologist John Rock, who was the director
of Brookline’s Reproductive Study Center. Rock and Pincus were both involved in research for
treatments for infertility. Reproductive medicine was an expanding field in the 1950s. Infertile
couples struggled in the midst of the baby boom, when it seemed as though everyone was procreating.
Many clinical researchers who became involved in the development of the pill also sought cures for
infertility. These physicians were interested in family planning. As one explained: “Every child should
be a wanted child. Those who want them should be able to have them; those who don’t should be able
to prevent them.”23
John Rock was among the physicians who worked on both fertility and contraception. Like Sanger
and McCormick, Rock had a powerful independent streak that led him to defy religious, legal, and
cultural taboos. The grandson of an Irish immigrant tailor and son of a liquor store owner, Rock grew
up with a spirit of adventure and risk taking. In high school he won a scholarship to travel in South
America, and he began his work life on a banana plantation in Guatemala. Rebelling against his boss
in Guatemala and then against his father, who wanted him to become a businessman, Rock entered
Harvard College and pursued a career in medicine. He grew up true to his Catholic faith but with a
strong belief that his conscience should be his most important guide in life.24
Rock became one of the pioneering physicians in the field of reproductive medicine, working on
both infertility and contraception. A practicing Catholic and a social conservative, he believed that in
certain circumstances birth control was medically necessary, but only when there were particular
health reasons to avoid pregnancy. Highly critical of routine use of birth control, he held “no brief for
those young or even older husbands and wives who for no good reason refuse to bear as many children
as they can properly rear and as society can profitably engross.”25
But Rock took issue with the Catholic Church’s prohibition against birth control, because it
prevented physicians from acting in what they believed to be their patients’ best interests. In the
1940s, he taught students at the Harvard Medical School how to fit patients with diaphragms—a bold
move for a Catholic doctor in a state that outlawed the distribution of birth control information and
devices. He advocated the lifting of legal restrictions that hindered physicians from providing patients
with contraceptives. Later, he clashed openly with the Church, arguing that the pill was consistent
with Catholic precepts. Rock insisted that it was not an “artificial” means of birth control because the
hormones in oral contraceptives mimicked those that occurred naturally in pregnancy.26
Rock agreed to work with Pincus to test the potential for the hormone progesterone to inhibit
ovulation in humans. Now all they needed was the essential ingredient: women who would volunteer
for the studies. Rock found sixty volunteers. Some of the women who joined the clinical trials were
infertility patients at the Free Hospital for Women; other volunteers were nurses at the Worcester
State Hospital. The complicated procedure included daily basal temperature readings, vaginal smears,
and urine collection as well as monthly endometrial biopsies. The results were promising: The drug
apparently inhibited ovulation. But there were problems with the study. The numbers were too small,
and only half of the women complied with the rigorous protocol. The challenge was to find a large
group of volunteers who would be motivated to comply.
Katharine McCormick was frustrated by the difficulty of finding an adequate pool of volunteers.
“The headache of the tests is the cooperation necessary from the women patients. I really do not know
how it is obtained at all—for it is onerous—it really is—and requires intelligent, persistent attention
for weeks.”27 She was eager to begin a major clinical trial but daunted by the challenge of finding
women willing to participate.
Lacking access to volunteers, researchers turned to involuntary subjects. In one of the most
disturbing episodes in the development of the pill, Pincus forced fifteen psychiatric patients at the
Worcester State Hospital to participate in trials that would afford them no benefit. Unlike the women
in Rock’s earlier study, most of whom were infertile and eager to test the pill’s potential to
temporarily suppress ovulation, thus possibly stimulating the ovaries when the drug was withdrawn,
the psychiatric inmates were neither at risk of pregnancy nor hoping to become pregnant.
Experimental programs involving coercion were used to test other drugs as well at the time, before
professional standards prohibited such practices. Nevertheless, because the pill was tested on
physically healthy women who had nothing to gain by participating in the study and possibly a great
deal to lose in terms of unknown risks and side effects, serious ethical questions have been raised
about these tests.28
Critics have long faulted doctors, scientists, and pharmaceutical companies for exposing women to
dangerous tests of high-dose hormonal contraceptives. While there were certainly some clear cases of
abuse and unethical practices, such as the coercive studies using psychiatric patients, the testing of the
pill largely conformed to the standards of the day and often exceeded them. At the time there were few
regulations in place for the testing of drugs. Compared to other countries, the United States had
relatively stringent requirements for gaining government approval because of FDA regulations. But it
was not until 1962 that doctors were required to inform patients if the drugs they prescribed were
experimental. Standards of informed consent for the testing of drugs were in the distant future.29
Although progesterone and estrogen had been administered to women for decades to treat
gynecological disorders and prevent miscarriages, finding a large enough volunteer group to test the
contraceptive effectiveness of these hormones presented a major challenge. The laws against
contraception in Massachusetts, where small initial trials had been conducted, ruled out that state as a
site for a large study. John Rock had previously studied the pill for its “rebound effect” to encourage
fertility, with the hope that after an infertile woman stopped taking the pill, she would then start
ovulating and become pregnant. That research did not violate any laws. But Rock knew that if he tried
to test the drug as a contraceptive, he could face criminal charges resulting in steep fines and
imprisonment.
So the researchers considered several other possible sites for a study, within the United States as
well as outside the country. Katharine McCormick worried about finding a stable population of
willing and cooperative volunteers. “Human females are not easy to investigate as are rabbits in
cages,” she noted. She was concerned that if the women did not stay in one place to allow for adequate
follow-up exams, or if they did not take the pills consistently, “the whole experiment has to begin over
again—for scientific accuracy must be maintained or the resulting data are worthless.”30
In 1956, Rock and Pincus finally decided to conduct the first large-scale clinical trials in Puerto
Rico. The island appeared to be an ideal setting for several reasons: No laws prohibited contraception,
and in fact, there was already an established network of sixty-seven birth control clinics on the island.
With more than six hundred people per square mile, Puerto Rico was one of the most densely
populated areas of the world. Impoverished women living in crowded, disease-ridden conditions were
desperate for birth control. At the time, the only option available to them for reliable contraception
was sterilization, which had been vigorously promoted and was widespread on the island, due in large
measure to funding from the wealthy eugenicist Clarence Gamble, a longtime advocate of sterilization
of the poor. Puerto Rican women wanted a nonsurgical, reversible, and effective means of preventing
pregnancy. Women who volunteered for the studies were given pills containing 10 milligrams of
progesterone and small amounts of estrogen, many times greater than the pills on the market today.
But at the time researchers were uncertain whether lower doses of hormones would be effective, and
they wanted to be sure that the pill they tested would prevent pregnancy.31
In Puerto Rico, two women conducted the on-site trials, Dr. Edris Rice-Wray and Dr. Adaline
Satterthwaite. Rice-Wray, a faculty member at the Puerto Rico Medical School and director of the
Public Health Department’s Field Training Center for nurses, was medical director of the Puerto Rican
Family Planning Association. Working with Pincus and Rock, she set up a research site in a suburb of
San Juan. Satterthwaite, who like Rice-Wray was born and trained in the United States, established a
trial site in Humacao, a rural area. The women they recruited were eager to participate. Already
saddled with large families, many were in poor health and malnourished, longing for an effective yet
reversible contraceptive. So many women volunteered that some sites resorted to waiting lists.
The developers of the pill were particularly concerned about its safety. They put in place elaborate
precautions to monitor the health of the women who took part in the trials, such as frequent medical
exams and lab tests. Study participants in impoverished areas received medical attention vastly
superior to what was normally available to them. The researchers were particularly sensitive to the
effects of the pill because it was intended for healthy women. It was not a drug to cure a disease,
which could have been tested on patients who were already sick. By the standards of the day, the
studies were scrupulously conducted.
But there were serious problems with the trials. The high doses of hormones caused side effects
such as nausea, headaches, and dizziness. In 1956, Rice-Wray reported that 17 percent of the
participants complained of these symptoms. Even though the 10-milligram pill “gives one hundred
percent protection against pregnancy,” she concluded that it caused “too many side reactions to be
acceptable.” Rice-Wray tried to convince Rock and Pincus to end the study because of these problems,
but they considered these symptoms to be minor and dismissed her concerns. Pincus claimed that
many of the women’s symptoms were psychosomatic. He asserted, “Most of them happen because
women expect them to happen.” But the side effects were real and serious, prompting many women to
drop out of the study.32
Although women continued to volunteer for the studies, the investigators faced considerable
hostility from suspicious officials and the media. Local newspapers published false reports that a
“woman dressed as a nurse” was distributing “sterilizers” and that “Nordic whites” were using “the
coloured races as ‘guinea pigs.’ ” Priests and disapproving husbands also persuaded some women to
drop out of the studies.33 Eventually, Rice-Wray and Satterthwaite were both forced to resign their
positions. Yet there is no evidence that the researchers intentionally put women at risk. Women
volunteered freely and enthusiastically.34
The women of Puerto Rico were not the only ones taking part in testing the oral contraceptive.
Rock, Pincus, and their colleagues conducted studies in Haiti, Massachusetts, and New York City as
well. Other researchers were also testing the pill at sites inside and outside the United States,
including Tennessee, Seattle, Chicago, Los Angeles, Mexico City, Hong Kong, Australia, Ceylon,
Japan, and Britain. The data collected from these trials contributed to the development of the
compound that eventually received approval for marketing. After the drug was cleared in 1957 for the
treatment of various gynecological disorders, developers in the United States and Britain began the
process of gaining permission to market the pill for use as a contraceptive.35
The approval process took place in several stages. The United States had a formal regulatory
procedure; Britain did not. Nevertheless, Searle’s product, known as Enovid in the United States and
Enavid in Britain, came on the market in both countries in 1957 as a treatment for infertility and
menstrual disorders. Three years later Searle submitted a request that Enovid be allowed for use as a
contraceptive. British authorities refused to discuss or even monitor Enavid for contraceptive use,
insisting that the issue was too politically and morally sensitive. In the United States, the 1938 Food,
Drug, and Cosmetic Act defined a drug not simply as something intended to treat a disease, but as a
product “affecting the structure or function of the body.” Under that definition, all contraceptives fell
under FDA jurisdiction.
Government officials tried to distance themselves from the social and moral implications of the
oral contraceptive by concentrating exclusively on safety concerns. As the FDA Deputy Commissioner
wrote to a U.S. senator, “Although we recognize the presence of moral issues, they do not come within
the jurisdiction of the FDA. Our consideration has to be confined to safety for intended use.”36 At the
time, the FDA was overwhelmed with thousands of requests for approval of new drugs, with only a
few regulators on staff. The application to market Enovid as a contraceptive was assigned to Dr.
Pasquale DeFelice, a young obstetric gynecologist who was still completing his residency. Because of
his lack of experience and the paucity of medical experts available within the FDA, the agency relied
heavily on the advice of outside medical practitioners. In February 1960, the FDA wrote to seventyfive physicians at leading medical schools around the country asking them to evaluate the safety of
Enovid. Many responded positively, reporting that they had found the drug to be safe and effective for
short-term use in treating gynecological problems. But those reports were largely irrelevant to the
question of the pill’s long-term use as a contraceptive.
A dissenting opinion came from Dr. Edward Tyler, head of the Planned Parenthood Clinic in Los
Angeles and a clinical researcher who had treated nearly two hundred patients for menstrual problems
and infertility using Enovid as well as other hormonal compounds. Tyler had serious reservations
about the pill’s safety. While John Rock was satisfied that the pill was safe and Gregory Pincus
dismissed the side effects as mere nuisances, Tyler found that a significant number of his patients
experienced abnormal bleeding, weight gain, swelling from fluid retention, and other problems. In
1958, he reported those concerns at a medical meeting and caught the attention of an FDA official in
attendance. Because he had no vested interest in any particular formulation of the oral contraceptive,
the FDA considered Tyler to be more neutral than Pincus or Rock, who had both tested and promoted
Enovid.
Tyler’s concerns slowed down the approval process, causing Rock and Pincus considerable
annoyance and frustration. But the FDA would not grant approval as long as Tyler had misgivings.
After carefully reviewing the responses to the questionnaire, an FDA official interviewed Tyler as a
final step in the process. Tyler assured the official that his earlier concerns had been addressed, and
that he was now convinced that Enovid was safe. Finally, on May 9, 1960, the FDA announced
provisional approval of the pill and, on June 23, officially approved the 10-milligram dose of Enovid
for daily use as a contraceptive. Because there were still concerns about its long-term safety, the FDA
limited use of the pill to two consecutive years.37
Of course, John Rock, Gregory Pincus, Edward Tyler, and the scores of researchers involved in
developing the oral contraceptive could not have brought the pill to market without the women who
participated in its testing. Margaret Sanger and Katharine McCormick lived to see the fruits of their
efforts. By the time they died—Margaret Sanger in 1966 at the age of eighty-six, Katharine
McCormick the following year at age ninety-two—millions of women were “on the pill.” Yet with the
exception of Sanger and McCormick, the pill’s most ardent advocates saw its potential not in terms of
women’s emancipation but rather as a miracle drug that would solve the problems of the world.